This T32 application for a postdoctoral fellowship program in cardiovascular outcomes research is designed to meet a regional and national need for more scholars in cardiovascular outcomes and quality of care research by extending and improving an existing AHA-funded outcomes research training program that is unique in the Midwest. This Mid America Heart Institute / University of Missouri-Kansas City research program provides a robust foundation with which young investigators can acquire the techniques of cardiovascular outcomes and quality of care research. As such, it has grown to be the central unifying research program in our region of 2 medical schools and 4 hospital systems and serves as a specialized training experience for more distant programs, including Washington University in St. Louis and the University of Iowa. Our objective is to recruit and mentor outstanding potential researchers who are motivated to learn and apply outcomes research principles and techniques in performing comparative effectiveness research and translating existing knowledge to clinical practice. The 2-year training program is comprised of 3 synergistic components: 1) a basic foundation of general skills for clinical research (including a Masters degree in clinical research), 2) specialized skills for outcomes research and academic 'survival skills' (our outcomes-based core curriculum), and 3) hands-on research. Courses are highly interactive and provide fellows opportunities to actively work with the concepts being studied. Hallmarks of the research experiences include multi- disciplinary group mentorship, individualized to meet the needs of each trainee, access to numerous existing data sources, and highly experienced statistical support. Enhancements planned for the existing program include adding training opportunities within Kansas City; creating new opportunities to do external research rotations at Yale University to support exposure to the use of CMS data; enhancing the current strength of the training program's use of secondary data to include a greater emphasis on primary data collection for small pilot projects; and extending mentorship support beyond the 2-year, focused training program. Administering the program will be a qualified program director, supported by an experienced associate and assistant director. Leaders in 7 methodological cores (large database analysis, economics and decision analysis, qualitative and implementation research, study design methodology and statistics and community-based participatory research) are committed to supporting the training program. The program will be supported by internal and external advisory committees. Collectively, our committed team will provide a formal training, mentorship and evaluation program with highly proven success in supporting the ability of fellows to make significant contributions to the scientific literature and to embark on successful academic research careers.